P A R P A K 257 limbs and all other affected parts. In most instances death takes place from some intercurrent disease before maturity. Paralysis Ayitans or Trembling Palsy is a peculiar form of paralysis characterized chiefly by trembling movements in certain parts, tending to become more widely diffused throughout the body. It is a disease of advanced life. The symptoms come on somewhat insidiously, and first show themselves chiefly by involuntary tremblings of the muscles of the fingers, hand, arm, or leg, which are aggra vated on making efforts or under excitement. These trembling movements become more marked and more extensive with the advance of the disease, and along with the tremors there generally occurs increasing weakness of the affected muscles. This is very manifest in walking, the act being performed in a peculiar tottering manner with the body bent forward. The trembling movements cease during sleep. This disease is a chronic one, and is intractable to treatment, but life may be prolonged for many years. Glosso-labio-laryngeal Paralysis is a form of paralysis affecting, as its name indicates, the functions of the tongue, lips, and larynx (besides others), and depending upon disease of certain localities in the medulla oblongata from which the nerves presiding over these functions arise. The symptoms come on slowly, and are generally first manifested in some difficulty of speech owing to impaired movements of the tongue. Associated with this there is more or less difficulty in swallowing, owing to paralysis of the muscles of the pharynx and soft palate, by which also the voice is rendered nasal. With the advance of the disease the paralysis of the tongue becomes more marked. It cannot be protruded, and frequently undergoes atrophy. Certain of the facial muscles become implicated, especi ally those in the neighbourhood of the mouth. The features become expressionless, the lips cannot be moved in speaking, the mouth remains open, and the saliva flows abundantly. The muscles of the larynx may also be involved in the paralysis. In the later stages of the malady the power of speech is completely lost, the difficulty in swallowing increases to a degree that threatens suffoca tion, the patient s condition altogether is one of great misery, which is in no way mitigated by the fact of his mental power remaining unaffected. Complications con nected with the respiratory or circulatory functions, or disease affecting other parts of the nervous system with which this complaint may be associated, often terminate the patient s sufferings, and in any case life is seldom pro longed beyond two or three years. 3. Peripheral Paralysis, or local paralysis of individual nerves, is of not unfrequent occurrence. The most com mon and important examples of this condition can only be briefly referred to. Facial Paralysis, Bell s Palsy, are the terms applied to paralysis involving the muscles of expression supplied by the seventh nerve. It is unilateral, and generally occurs as the result of exposure of one side of the head to a draught of cold air which sets up inflammation of the nerve as it passes through the aqueductus Fallopii, but it may also be due to injury or disease either affecting the nerve near the surface or deeper in the bony canals through which it passes, or in the brain itself involving the nerve at its origin. Here the paralysis is manifested by a marked change in the expression of the face, the patient being unable to move the muscles of one side in such acts as laughing, whistling, itc., or to close the eye on that side. The mouth is drawn to the sound side, while, although the muscles of mastication are not involved, the food in eating tends to lodge between the jaw and cheek on the palsied side. Occasionally the sense of taste is impaired. In the ordinary cases of this disease, such as those due to exposure, recovery usually takes place in from two to six weeks, the improvement being first shown in the power of closing the eye, which is soon followed by the disappearance of the other morbid phenomena. When the paralysis proceeds from disease of the temporal bone, or from tumours or growths in the brain, it is more apt to be permanent, and is in many cases of serious import. Throughout there is no diminution of sensibility in the paralysed muscles ; but they early lose their reaction to faradization, retaining that to galvanism. Lead Palsy is a not uncommon form of local paralysis. It is due to the poisonous action of lead upon the system, and, like the other phenomena of lead poisoning, affects chiefly workers in that metal (see LEAD). The pathology of this disease is still unsettled, but it is believed to depend upon the local effect of the lead upon the nerves of the part rather than to any disease, at least in the first instance, of the nerve centres. The paralysis in this case is as a rule confined to the muscles of the forearm which extend the hand, and as they lose entirely their power the hand cannot be raised when the arm is held out, which gives rise to the condition termed " wrist drop." The paralysis may come to affect other muscles of the arms as well as certain of those of the legs and trunk, and along with the paralysis there occurs wasting of the affected muscles and loss of their electrical reactions. Occasionally in severe cases other nervous phenomena, such as convul sions, delirium, itc., may become superadded. The symp toms usually disappear on the removal of the patient from the source of lead contamination, along with the applica tion of the treatment appropriate to poisoning with this metal, and all the more speedily if the case has not been of long duration and the affected muscles have not under gone atrophic change. A form of peripheral paralysis not unlike the last occasionally results from chronic alcoholism. The paralysis occurring after diphtheria, another example of the peri pheral variety, has been already referred to (see DIPH THERIA). Treatment. It is impossible in a general notice like the present to refer at any length to the treatment of paralysis. The conditions of the disease in any particular case and its associations are so manifold that they can only be fully understood and appreciated by the medical expert under whose direction alone treatment can be advantageously carried out. It may be stated generally, however, that, since paralysed muscles tend to undergo certain degenera tive changes (see PATHOLOGY), it becomes an object in I treatment to endeavour to maintain as long as possible their molecular integrity. With this view, when pain and other acute symptoms which may be present have ceased, the use of nervine tonics such as iron, quinine, and strych nine, and the suitable dieting of the patient, are the best constitutional remedies ; while of local applications fric tions or massage, but more particularly the employment of electricity, will be found of service, the latter agent often yielding markedly beneficial results. (j. o. A.) PARAMARIBO, the administrative and commercial capital of Dutch Guiana or Surinam, is situated in 5 44 30" N". lat. and 55 12 54" W. long., on the right bank of the Surinam, which, though at that point 20 miles from the sea, is a tidal river nearly a mile broad and 18 feet deep. Built on a plateau about 16 feet above low-water level, Paramaribo is well-drained, clean, and in general healthy ; the straight canals running at right angles to the river, the broad, straight, tree-planted streets, the spacious squares, and the solid if plain looking public buildings would not be unworthy of a town in the Netherlands. Among the more conspicuous edifices XVIII. - - 33
